The death agony of the anti-MMR campaign
Even after a Cochrane review found 'no credible evidence' of a link between MMR and autism, sections of the British media just won't let it lie.
A recent Cochrane systematic review concluded that there was ‘no credible evidence’ of a link between the measles, mumps and rubella vaccine (MMR) and either inflammatory bowel disease or autism (1). The virtually unanimous verdict of the media was that this review, following a series of studies coming to the same conclusion, meant that the scare launched by Andrew Wakefield’s now notorious Lancet paper in 1998 was finally over. Not quite.
The publication of the Cochrane review provoked demands that the Daily Mail and Private Eye acknowledge their past mistakes and apologise for their role in promoting the MMR-autism scare. Instead the Mail published a feature by leading columnist Melanie Phillips insisting that claims that MMR was safe were ‘a load of old baloney’ (2). Phillips proclaimed that, far from having received the ‘all-clear’, the ‘MMR scandal’ was ‘getting worse’. When Guardian science writer Ben Goldacre observed that Phillips seemed ‘to misunderstand basic epidemiology’ (3), she accused him of ‘smear and evasion’ (4). The hapless Eye stumbled between pleading that it had always been pro-immunisation and insisting that Wakefield had been unjustly ‘completely vilified’ for claiming a link between MMR and autism (though neither he nor anybody else has substantiated this since it was first suggested, nearly 10 years ago) (5).
Phillips’ defiant articles and the Eye’s apologia for Wakefield stand as symbols of the woeful role of the media in the course of the MMR controversy. It is true that the MMR-autism scare did not start in the press. Both a reputable London teaching hospital and a prestigious medical journal failed to protect the public from junk science. Yet, once Wakefield decided to go public with his anti-MMR campaign, the media played a major part in promoting the scare. Phillips’ response to the Cochrane study follows the familiar themes of numerous anti-MMR articles over the years, including several by Phillips herself.
In her response to Goldacre, Phillips objects to his charge that she is scientifically illiterate: ‘this argument has been used to tell parents that the evidence of their own eyes is not true.’ But this statement eloquently confirms Goldacre’s point. Scientists have been contradicting the evidence of people’s senses – and of common sense – ever since Galileo advanced the heretical, and counterintuitive, view that the Earth revolved around the sun (could he not see with his own eyes that the sun rose in the east and set in the west?) (6). Parents who cite the evidence of their own eyes that their children became autistic after receiving the MMR vaccine are in the grip of one of the oldest of commonsensical fallacies – that association proves causation. Even though parents may cling passionately to the belief that MMR caused their children’s autism, it is the responsibility of scientists to tell them that intensive scientific research in a number of disciplines indicates that the evidence of their own eyes is not true. While acknowledging the provisional character of all scientific truth and the difficulties in determining it, the Cochrane review concludes that the truth about MMR is that it does not cause autism (though it does protect children against three potentially serious diseases).
It is important that scientists do not shirk the onerous responsibility of telling parents the truth about the MMR-autism link, because the costs of denying this truth are high. The false belief in the MMR-autism link has led thousands of families of autistic children into a doomed quest for compensation from vaccine manufactures and has caused thousands more parents to feel anger, anxiety and guilt over giving their children the vaccine. The scare has led to a significant decline in vaccine uptake that may yet lead to new epidemics of measles and other diseases. For a scientist to promote the notion of a link between MMR and autism for which he cannot produce compelling evidence is socially irresponsible. It is also irresponsible for journalists to endorse the anti-MMR campaign without critically examining the claims of its promoters and providing an accurate account of the overwhelming weight of scientific evidence against the autism link.
Goldacre rightly points out that Phillips misunderstands the nature of a systematic review. She misinterprets any criticism of studies of MMR safety, or any expression of uncertainty about their conclusions, as a vindication of Wakefield’s case. She echoes the mantra of anti-MMR campaigners that epidemiological methods are not suitable to discover an association between MMR and autism, when this is precisely the point of such methods. Epidemiology has successfully identified a link between MMR and the skin rash resulting from a sharp fall in blood platelets (thrombocytopenic purpura), a (generally benign) condition much rarer (around 20 cases a year in Britain) than the so-called epidemic of autism attributed to MMR.
Indeed, this is why Wakefield explicitly invited epidemiological studies in his Lancet paper – only to repudiate this approach when one study after another failed to support his hypothesis. Having started out blaming MMR for causing an epidemic of autism, campaigners are now reduced to the absurd claim that it causes a number of cases too small to measure by epidemiological methods.
Phillips endorses Wakefield’s claims. She insists that his discovery of ‘autistic enterocolitis’ has been replicated around the world and that ‘vaccine-strain’ measles virus has been found in cerebrospinal fluid (CSF) samples from autistic children, though she fails to mention that these few studies have been carried out by Wakefield or his collaborators and are universally dismissed by reputable authorities. Phillips takes exception to Goldacre’s characterisation of the Journal of American Physicians and Surgeons, which has published several articles by Wakefield and his supporters, as the ‘magazine of a right-wing US pressure group well known for polemics on homosexuality, abortion and vaccines’. But Goldacre’s description is accurate. Until two years ago the journal was known as the Medical Sentinel, when it was relaunched declaring a continuing ‘commitment to publishing scholarly articles in defense of the practice of private medicine’ (7). Recent issues include features entitled ‘Illegal aliens and American medicine’ (Spring 2005) and ‘Homosexuality: some neglected considerations’ (Fall 2005), which make the Daily Mail appear positively liberal.
Echoing Wakefield, both the Daily Mail and Private Eye have repeatedly quoted claims that measles virus has been discovered in bowel and CSF samples obtained (by invasive investigations of dubious clinical value and ethical propriety) from autistic children. The key authorities are Professor John O’Leary from Dublin and Dr Jeffrey Bradstreet from Florida. O’Leary published two papers in 2002 which Wakefield immediately claimed supported his theory, a claim explicitly rejected by O’Leary who insisted that his work ‘in no way establishes any link between the MMR vaccine and autism’ (8). The failure of O’Leary’s subsequent investigations of children whose parents were pursuing compensation to come up with reliable evidence of measles infection was the key factor in the collapse of the litigation. After receiving very substantial legal aid fees for these studies, it seems that O’Leary has now abandoned this field.
Dr Bradstreet has variously presented himself as a paediatrician, a Christian family physician, a professor of neuroscience and as an expert/lecturer on autism. He was formerly a radio talk show host and an evangelical preacher: according to the website of his Good News Doctor Foundation, the multi-talented Bradstreet has also conducted ‘vast research’ into the Bible, which has given him a ‘clear grasp’ of Scripture (9). His centre in Melbourne, Florida was exposed in Brian Deer’s Channel 4 Dispatches documentary in November 2004 as the source of a range of quack remedies for children with developmental disorders, including Bradstreet’s personal product, ‘Sea Buddies Concentrate’, advertised as a ‘high potency formula with five ingredients that help support healthy focus and concentration in children’. While Wakefield, Phillips and Private Eye may have faith in Bradstreet, the rest of the world awaits independent replication of his results.
It is extraordinary that, after nearly a decade of Wakefield’s empty promises that he would prove his critics wrong, sections of the British press appear to be still captivated by his self-professed status as a maverick and crusader against the establishment. His posture of martyrdom and victimhood seems to have a particular appeal for Phillips. The price of this mutual self-indulgence is borne by the real victims of the MMR-autism fiasco – parents of autistic children and parents facing decisions about immunisation.
With a few notable exceptions – such as Brian Deer, whose work for The Sunday Times and Channel 4 helped to discredit Wakefield’s Lancet paper – British journalists have a poor record on MMR and, indeed, on autism. It is good news that Deer and Channel 4 have won a high court ruling against Wakefield’s attempt to delay the hearing of his libel claim against them (10). Mr Justice Eady took particular exception to what he described as Wakefield’s wish to ‘use the existence of the libel proceedings for public relations purposes, and to deter other critics’. Wakefield has also tried to silence the Liberal Democrat MP Evan Harris and has sought to restrict the Department of Health from ‘supplying the public with such information as it thought appropriate’ by providing a link to Deer’s website. Eady objected to Wakefield using libel proceedings as ‘a tool for stifling further criticism or debate’ over an important public issue and insisted that the case should go ahead in the near future. Wakefield may be depicted in the Mail and the Eye as a heroic victim, but he does not hesitate to use his lawyers to bully critics.
While journalists have lionised Wakefield (who is now in private practice in Texas), real scandals – such as the recent death of an autistic boy from Britain undergoing mercury chelation therapy in the USA, or the inadequacy of respite services revealed by the conviction of a 67-year-old mother for killing her adult autistic son when she could no longer cope with his violent behaviour – have largely been ignored (11). If children die from measles, the MMR scandal may indeed get worse.
Dr Michael Fitzpatrick is a GP and author of MMR and Autism: What Parents Need to Know (buy this book from Amazon (UK) or Amazon (USA)). An edited version of this article, Why can’t the Daily Mail eat humble pie over MMR?, appears in this week’s British Medical Journal.
(1) Demichelli V, Jefferson T, Rivetti A, Price D, ‘Vaccines for measles, mumps and rubella in children’, The Cochrane Database of Systematic Reviews 2005, issue 4, 19 October 2005
(2) MMR: the unanswered questions, Melanie Phillips, Daily Mail, 31 October 2005
(3) The MMR sceptic who just doesn’t understand science, Ben Goldacre, Guardian, 2 November 2005
(4) The case against me boils down to smear and evasion, Melanie Phillips, Guardian, 8 November 2005
(5) ‘The lessons of Cochrane’, Private Eye 1145, 11-24 November 2005
(6) The Unnatural Nature of Science, Lewis Wolpert, Faber, 1992
(7) Journal of American Physicians and Surgeons
(8) MMR and Autism: What Parents Need to Know, Michael Fitzpatrick, Routledge, 2004, p127-8
(9) Good News Doctor Foundation
(10) Judgment, Hon Justice Eady, Royal Courts of Justice, 4 November 2005. Also see High Court judge criticises Andrew Wakefield for trying to silence his critics, Clare Dyer, British Medical Journal, 12 November 2005
(11) When quackery kills, by Dr Michael Fitzpatrick
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